New Consult Codes

The correct inpatient consultation codes for a first evaluation are 99221-99

223. These codes are used for the inpatient History and Physical (H & P), as well as any specialty consultation (limited to one visit from each specialty).

Code 99452 is reported by the requesting/treating physician/QHP (e.g., the p

rimary care physician). The table outlines distinctions between consultant codes 99446-99449 and the new consultant code 99451 as well as distinct features of code 99452. Consultant codes99446-99449 and 99451: can be reported for new or established patients

These codes are used to bill for office consultations with new or establishe

d patients. These codes are also used to bill for consults performed on patients in the ER or admitted under "observation" status. Internists performed a total of 1,012,718 of these services in 2003. A consult is provided by a physician whose opinion or advice is ...

Consultation Codes 99241- 99245 Consultation codes are used to represent sec

ond-opinion visits.

A consultation code may be billed out for an established patient as long as

the criteria for a consultation code are met. There must be a notation in the patient’s medical record that consultation was requested and a notation in the patient’s medical record that a written report was sent to the requesting physician.

New Office Patients (99201-99205) These codes are used to bill for new patie

nts being seen in the office. A new patient is defined as someone who has never been seen by you or a physician in the same specialty in your group OR who has not been seen by you or a physician in the same specialty in your group for at least three years.

Another important difference between the codes is that the new patient codes

(99201–99205) require that all three key components (history, exam and medical decision making) be satisfied, while the...

CPT code 99243: Office consultation for a new or established patient, which

requires these 3 components: a detailed history, a detailed examination, and medical decision making of low complexity. CPT code 99244: Office consultation for a new or established patient, which requires these 3 components: a comprehensive history, a comprehensive ...

Z71.89 is a billable/specific ICD-10-CM code that can be used to indicate a

diagnosis for reimbursement purposes. The 2021 edition of ICD-10-CM Z71.89 became effective on October 1, 2020. This is the American ICD-10-CM version of Z71.89 - other international versions of ICD-10 Z71.89 may differ.

As the patient admitted to psychiatrist hospital we need to code inpatient C

PT codes (99221-99233) series based upon initial and subsequent day in hospital and if the patient receives any consultation then consultation codes (99251-99255) if it is meeting the consultation criteria.

A number of code changes took place in CPT 2006 regarding consultation E/M c

odes. Specifically, the follow-up inpatient consultation code category (99261–99263) was deleted, with instructions to report instead the subsequent hospital care codes (99231–99233) or subsequent nursing facility care codes (99307–99310), whichever is applicable.

UnitedHealthcare (UHC) announced in the March issue of its Provider Network

Bulletin that it will discontinue payment for consultation codes (CPT 99241–99255) later this year. Implementation of the policy will occur in two phases. On June 1, 2019, UHC will eliminate the consultation codes for practices with contracted rates based on a stated year 2010 or... [Read More]

In the early days of telemedicine, CMS required telemedicine codes to be sub

mitted with place of service (POS) 2 for telehealth. Then, CMS changed it to POS 11 for office. Since then, Medicare Administrative Contractors (MAC) have been receiving hundreds of redetermination requests to change the POS on claims from 02 to 11.

CPT code for Consultation is of two types and this code selected based on th

e place where the service provided. Outpatient – CPT code for Consultation (New/Established Patient) Inpatient – CPT code for Consultation (New/Established Patient) Outpatient – CPT Code for Consultation is:

Interprofessional consultation codes (99446-99451) are reported by consultin

g providers who communicate with treating providers regarding a diagnosis or management of a patient’s problem. These services support a team-based approach to care and don’t include physician interaction with the patient.

UnitedHealthcare (UHC) is joining the ranks of those carriers that no longer

cover consult codes (99241-99245 and 99251-99255), effective Oct. 1, 2017. This notification was released in UnitedHealth’s June 2017 bulletin in which it noted its commitment to ensure that there will be multiple com...

The MOH (Ministry of Health) has released new OHIP billing codes pertaining

to COVID-19 pandemic response. These temporary OHIP billing codes are effective as of March 14, 2020. You have the option of using any type of video conferencing software for your virtual patient consult such as: Microsoft Teams, Zoom, Cisco's Webex.

Medicare stopped recognizing and paying consult codes, but consults are stil

l requested and provided to inpatients every day. The question is, how should they be billed? If the documentation supports an initial hospital service, use codes 99221-99223, initial hospital care codes.

For Medicare patients, you would bill a consult with an initial inpatient co

de, so billing a shared/split visit would be OK.” Here’s our dilemma: We have a number of commercial payers who say they follow Medicare rules on split/shared visits, but they still recognize consult codes 99241-99245 (for office consults) and 9925199255 (initial ...

Follow-up consultations. These services should be reported as established pa

tient visits (CPT 99211-99215) if initiated by the physician consultant or the patient. Consultations required by hospital rules and regulations. Anesthesia consultations. Telephone consultations. Radiological (except for therapeutic services) or pathological consultations.

Consultations for Medicare patients are reported with new patient (99201–9

9205) or established patient (99212–99215) Current Procedural Terminology (CPT) codes. For non-Medicare patients (unless otherwise instructed by a payor), office or other outpatient consultations are reported with codes 99241–99245.

Observation consult I do coding for a multispecialty practice that employs b

oth hospitalists and specialists. When a patient is placed in observation and a specialist consult is called, what code set do I use to bill the consult: 99201-99205 (new patient office visit) or 99212-99215 (established patient office visit)?

CPT CODE and description 99243 - Office consultation for a new or establishe

d patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity.Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and ...

If you provide consultations to Cigna members, be aware that Cigna will soon

no longer pay those codes. For claims processed on or after Oct. 19, Cigna said in a recent payment update ...

The consultation codes were previously utilized when providers were asked to

consult on a specific aspect of a patient’s care and the payment was higher than merely reporting for initial or new patient services. In March 2006, the Office of Inspector General (OIG) released a report titled "Consultations in Medicare: Coding and Reimbursement." ...

The New Office Visit code family uses the same level of service and document

ation requirements as in the Consult code family. However, for patients who have been seen in the past 3 years face-to-face by the same or another neurologist in the same practice, an Established Office Visit code is used in lieu of a consult code.

If billing a service that meets the criteria for a consult on a Medicare pat

ient, the service is billed with new and/or established patient office visits, using the new guidelines. If billed with a consult code, the clinician must follow the 1995/1997 guidelines in documenting the service and selecting the level of service.

As details of the new MBS items continue to develop, this page (and associat

ed fact sheets) will be updated. Telehealth Items for COVID-19 from 22 May 2020 Specialists: New MBS items have been introduced for telehealth and telephone services for anaesthetists - items 92701 and 92712, which mirror the existing service 17615.

HCPCS Level II Telehealth Codes Type of Service New Patient Established Pati

ent; G0406-G0408 : Follow-up Inpatient Consultation via Telehealth: X: G0425-G0427: Telehealth Consultation, Emergency Department: X: G0508, G0509 : Telehealth Consultation, Critical Care: X: X

The limitation of ten speed buttons in Epic Ambulatory has sometimes caused

confusion with billing the new patient visit codes or a consultation. A "new patient" is a patient who has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or ...

Two new prolonged service codes were created for use when outpatient E/M ser

vices exceed each 15 minutes beyond the highest level E/M code (99205, 99215). One is for use with Medicare patients (G2212) and the other is a CPT code (99417).

CPT code and Description. 99241, Office consultation for a new or establishe

d patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. 99242, Office consultation for a new or established patient, which requires these 3 components: An expanded problem focused history; An expanded problem focused ...

procedure code and description 99241 - Office consultation for a new or esta

blished patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family ...